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205 W. Lockeford St, Lodi, CA 95240 PR0232257 <br /> 06/20/2022 Program: UST <br /> PHOTO 1: <br /> 03/11/2022 designated operator(DO) ins ection re ort si ned late b the owner/o erator(more than 72hrs) <br /> 1• 1)esl U 4ppe Desi Underground Storage Tank <br /> FgCILIPYI g118tecl USndergrounddixXlll gnated UST Operator Visual inspection Report <br /> CERS ID 10 NFORIVIgTION T Operator Storage Tank 5' OWNER/OPERgTOR DESCRIPTION OF FOLLOW- <br /> ual Ins UP ACTION <br /> 11 P! 10180 Na 180gg1 inspection Report Number the follow u <br /> me v actions to correspond to a <br /> ppropriate compliance issues from Section 3. <br /> 2. iW at LOCse I'd Stop Market N 1qa Inspection Date 3111/2022 <br /> 2• DESIG Looketord Street <br /> Name or Design atedST OPERATOR INFO Lod, ZIP Code <br /> Curtis Car enter RMATION 195240 <br /> ICC ertific UST Operator <br /> 65 ation <br /> Phone <br /> 3 COMPLIANCE ISSUES 16-372.1 RRR <br /> Certfoabxpiration Date <br /> 70/26/2022 <br /> 6. OWNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> I have reviewed the results of the designated UST operator inspection report and provided a <br /> description of the action(s)taken or to be taken to correct any compliance issues discovered. <br /> Name of UST Owner/Operator(print) <br /> UST Owner/Operator Si atur <br /> Date Signed <br /> 3zulZZ <br /> 7. INSPECTI N CRY <br /> Has each follow-up action of Section 3 from the previous Designated UST <br /> Operator Inspection Report been completed appropriately? Yes No NA <br /> 4, CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION Attach documentation veri in a ro riate service to this re ort. <br /> 1 hereby certify that the visual inspection was performed in compliance with California Code $' RELEASE DETECTION ALARM HISTORY <br /> of Regulations,title 23,division 3,chapter 16,section 2716 and all information Attach a copy of the alarm history report/log to this report. <br /> herein is accurate. Is the monitoring system powered on and in proper operating mode? Yes No NA <br /> Provided <br /> Designated UST Operator Signature Has each alarm since the previous inspection been responded to appropriately? <br /> n Date Inspection Report provided top as <br /> documentation veri In appropriate service to this report.) <br /> 3/11/2022 Owner g <br /> Have all containment sumps,that have had an alarm since the previous <br /> CERS=California Environmental Reporting System,JCC=International Code Council,ID= designated UST operator inspection report,been responded to by a qualified <br /> Identification,NA=Not Applicable,UDC=Under-Dispenser Containment,UST=Under d service technician? <br /> Storage Tank group <br /> •All answers marked'No"must be described by the designated UST operator in Section 3. <br /> Page 1 Of <br /> Page 2 of 4 <br /> VICKY VANG-LEE, REHS Page 1 of 2 <br />